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Standard guidelines of care for chemical peels

Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indicati...

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Published in:Indian journal of dermatology venereology and leprology 2008-01, Vol.74 (7), p.S5-12
Main Author: Khunger, Niti
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description Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians′ qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient′s skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The e
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Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians′ qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient′s skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner′s solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.</description><identifier>ISSN: 0378-6323</identifier><identifier>EISSN: 0973-3922</identifier><identifier>EISSN: 1998-3611</identifier><identifier>PMID: 18688104</identifier><identifier>CODEN: IJDLDY</identifier><language>eng</language><publisher>New Delhi: Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)</publisher><subject>Acne ; Acne Vulgaris - pathology ; Acne Vulgaris - therapy ; Bacteria ; Biological and medical sciences ; Bones, joints and connective tissue. Antiinflammatory agents ; Chemexfoliation - methods ; Chemexfoliation - standards ; Chemical weapons ; Chemicals ; Dermatologic agents ; Dermatology ; Dosage and administration ; Drug therapy ; Formulae, receipts, prescriptions ; Glycolates - administration &amp; dosage ; Glycolates - therapeutic use ; Glycolic acid, Trichloroacetic acid, Salicylic acid ; Health aspects ; Humans ; Medical sciences ; Methods ; Patients ; Pharmacology. 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Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians′ qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient′s skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner′s solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. 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Antiinflammatory agents</subject><subject>Chemexfoliation - methods</subject><subject>Chemexfoliation - standards</subject><subject>Chemical weapons</subject><subject>Chemicals</subject><subject>Dermatologic agents</subject><subject>Dermatology</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Formulae, receipts, prescriptions</subject><subject>Glycolates - administration &amp; dosage</subject><subject>Glycolates - therapeutic use</subject><subject>Glycolic acid, Trichloroacetic acid, Salicylic acid</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Methods</subject><subject>Patients</subject><subject>Pharmacology. Drug treatments</subject><subject>Postoperative period</subject><subject>Practice guidelines (Medicine)</subject><subject>Psychological aspects</subject><subject>Risk factors</subject><subject>Side effects</subject><subject>Skin - drug effects</subject><subject>Skin - pathology</subject><subject>Skin Aging - drug effects</subject><subject>Skin Aging - pathology</subject><subject>Skin Diseases - pathology</subject><subject>Skin Diseases - therapy</subject><subject>Wound healing</subject><issn>0378-6323</issn><issn>0973-3922</issn><issn>1998-3611</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptkV1LJTEMhodFWb_2LyyDoHcjbTMfnUsRdQVhL1avh0ybnlPpaY_tjOC_tweProokkBCehJc3P4p91ndQQS_ETu6hk1ULAvaKg5QeGBN1C_xnscdlKyVn9X5x9m9CrzHqcjFbTc56SmUwpcJIpQmxVEtaWYWuXBO5dFTsGnSJfm3rYXF_dXl38ae6_Xt9c3F-W401h6kaZcPB9ARSd2OHokMYlTFacmj1qLAmQbUippqRtR3vFSdotBZc6VYbZeCwOH29u47hcaY0DSubFDmHnsKchravGesbyODxF_AhzNFnbQPvswjGoM5Q9Qot0NFgvQlTRLUgTxFd8GRsHp9zCQ3wrt4cPfuGz6E3Xny7cPphYUnopmUKbp5s8Okz-Hsrdx5XpId1tCuMz8PbQzJwsgUwZddNRK9seucEZ7wTrfwvcbRh87R3QkWLw9tQP-VkG9fhBWr0owg</recordid><startdate>20080101</startdate><enddate>20080101</enddate><creator>Khunger, Niti</creator><general>Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)</general><general>Indian Association of Dermatologists, Venereologists and Leprologists</general><general>Medknow Publications and Media Pvt. 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Antiinflammatory agents</topic><topic>Chemexfoliation - methods</topic><topic>Chemexfoliation - standards</topic><topic>Chemical weapons</topic><topic>Chemicals</topic><topic>Dermatologic agents</topic><topic>Dermatology</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Formulae, receipts, prescriptions</topic><topic>Glycolates - administration &amp; dosage</topic><topic>Glycolates - therapeutic use</topic><topic>Glycolic acid, Trichloroacetic acid, Salicylic acid</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Methods</topic><topic>Patients</topic><topic>Pharmacology. Drug treatments</topic><topic>Postoperative period</topic><topic>Practice guidelines (Medicine)</topic><topic>Psychological aspects</topic><topic>Risk factors</topic><topic>Side effects</topic><topic>Skin - drug effects</topic><topic>Skin - pathology</topic><topic>Skin Aging - drug effects</topic><topic>Skin Aging - pathology</topic><topic>Skin Diseases - pathology</topic><topic>Skin Diseases - therapy</topic><topic>Wound healing</topic><toplevel>online_resources</toplevel><creatorcontrib>Khunger, Niti</creatorcontrib><creatorcontrib>IADVL Task Force</creatorcontrib><collection>Bioline International Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Complete (ProQuest Database)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest_Research Library</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Indian journal of dermatology venereology and leprology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khunger, Niti</au><aucorp>IADVL Task Force</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Standard guidelines of care for chemical peels</atitle><jtitle>Indian journal of dermatology venereology and leprology</jtitle><addtitle>Indian J Dermatol Venereol Leprol</addtitle><date>2008-01-01</date><risdate>2008</risdate><volume>74</volume><issue>7</issue><spage>S5</spage><epage>12</epage><pages>S5-12</pages><issn>0378-6323</issn><eissn>0973-3922</eissn><eissn>1998-3611</eissn><coden>IJDLDY</coden><abstract>Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians′ qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient′s skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner′s solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.</abstract><cop>New Delhi</cop><pub>Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)</pub><pmid>18688104</pmid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0378-6323
ispartof Indian journal of dermatology venereology and leprology, 2008-01, Vol.74 (7), p.S5-12
issn 0378-6323
0973-3922
1998-3611
language eng
recordid cdi_proquest_miscellaneous_69400953
source Publicly Available Content Database; IngentaConnect Journals
subjects Acne
Acne Vulgaris - pathology
Acne Vulgaris - therapy
Bacteria
Biological and medical sciences
Bones, joints and connective tissue. Antiinflammatory agents
Chemexfoliation - methods
Chemexfoliation - standards
Chemical weapons
Chemicals
Dermatologic agents
Dermatology
Dosage and administration
Drug therapy
Formulae, receipts, prescriptions
Glycolates - administration & dosage
Glycolates - therapeutic use
Glycolic acid, Trichloroacetic acid, Salicylic acid
Health aspects
Humans
Medical sciences
Methods
Patients
Pharmacology. Drug treatments
Postoperative period
Practice guidelines (Medicine)
Psychological aspects
Risk factors
Side effects
Skin - drug effects
Skin - pathology
Skin Aging - drug effects
Skin Aging - pathology
Skin Diseases - pathology
Skin Diseases - therapy
Wound healing
title Standard guidelines of care for chemical peels
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